The "Childmyths" blog is a spin-off of Jean Mercer's book "Thinking Critically About Child Development: Examining Myths & Misunderstandings"(Sage, 2015; third edition). The blog focuses on parsing mistaken beliefs that can influence people's decisions about childrearing-- for example, beliefs about day care, about punishment, about child psychotherapies, and about adoption.
See also http://thestudyofnonsense.blogspot.com

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Saturday, March 16, 2013

Looking over the details of attachment therapy web
sites is always interesting and revealing. Somehow, laborers in the attachment
biz seem to make the same mistakes repeatedly. Maybe they never read anything
that contradicts their viewpoints-- but
of course that would mean omitting a great deal of relevant material, without
which an educated perspective is impossible.

Today, I
notice that at www.instituteforattachment.org,
mouthpiece of the Institute for Attachment and Child Development in Colorado,
includes a message called “Beware of Attacks on Attachment Therapy”. The
author, Forrest Lien, provides a mixture of truths, half-truths, and errors to
support his argument that people like me are mistaken in their concerns about
attachment therapy.

Lien distances his organization from the lady formerly
known as Connell Watkins, but also describes Watkins as having “wrapped a child
up in a blanket which affected her breathing and she died”. This description
seems to me to parallel the statement that Jesus was in an upright position
with his arms extended, this influenced his health, and he passed away. Both
are true, but a bit incomplete. Lien’s comments about Candace Newmaker may
appeal to those who have seen the related “Law & Order” episode, in which
the scriptwriters avoided the issue by having the child’s death due to an
allergic reaction to the blanket. But the reality is that Candace suffocated
because of pressure exerted against her immobilized body by a number of large
adults who believed they were imitating the experience of childbirth and that
this would cause Candace to be the “real” attached child of her adoptive
mother. Silly and pointless as it may be, rebirthing should not be fatal. It
was fatal in this case because of the factor Michael Shermer has called “death by
theory”. That is, Watkins and her fellow-therapists were convinced of the basic
tenet of attachment therapy, promulgated by Foster Cline, that a display of
power and authority was necessary in order for a child to become attached to a
parent. Watkins persisted in her actions for 70 minutes, ten times longer than
the usual rebirthing session-- 70
minutes in which the child initially begged for release, vomited, defecated,
and for the last 30 minutes was silent. It was not the blanket that affected
Candace’s breathing; it was the deep conviction of the therapists that in order
to be successful they must ignore the child’s “lies” and force her compliance.

Lien is perfectly correct in saying that rebirthing
is not holding therapy, and it is wrong to equate the two. This error on the
part of a Congressional resolution and of the American Psychological Association
has caused a great deal of trouble, although it pleased holding therapists, who
were happy to point the finger at rebirthing and away from their own principles
and practices. In fact, rebirthing is quite unlikely to do either harm or
good-- unless it is intensified to a
dangerous level by beliefs like those Watkins held.

Interestingly, Lien notes that his organization
stopped using holding therapy in 2006 (even though, as they state, it was not
the same thing as rebirthing). Six years after Candace Newmaker’s death!
Several years after a number of publications pointed out other child deaths
associated not only with the therapy, but with the belief system that equates
obedience with attachment! Can we believe that people who took that long to
drop a particular practice have also dropped all of the harmful mistaken beliefs
that supported the practice? I find it difficult to believe, and my
difficulties are confirmed by the rest of the www.instituteforattachment website.

As usual, some of the principles that make
attachment therapy dangerous are seen in the list of symptoms of Attachment
Disorder given on this site. There we are, at “What is Attachment Disorder?”
-- the same old same old claimed symptoms,
totally different from the characteristics of Reactive Attachment Disorder as
described in DSM. Manipulativeness, lack of conscience, remorse, or empathy,
inability to give or receive love, lack of cause and effect thinking (ever
wonder how they can be so manipulative without this?), lying, destructiveness,
cruelty, and of course superficial charm. But Reactive Attachment Disorder is
officially characterized by either excessive clinging and dependency on
caregivers or by a lack of normal preference for familiar people. Where did the
IACD Attachment Disorder list come from?
It’s a combination of a number of old checklists, including one that’s supposed
to identify psychopathy. How did this list get associated with Reactive
Attachment Disorder, the term used at several places on the website? Do the
website authors hold that Reactive Attachment Disorder is the same as
Attachment Disorder? If not, what is the evidence that there is a distinct
disorder called Attachment Disorder? If www.instituteforattachment.org
is not sure what problem it’s treating, it seems a bit arrogant to declare that
the treatment is a safe and effective one.

Given the apparent confusion about the problems
being treated, perhaps, it’s not surprising that www.instituteforattachment.org
features among “research articles” a piece on the Randolph Attachment Disorder
Questionnaire, which makes many of the assumptions noted in the last paragraph. The
RADQ is an instrument that has never been published in a peer-reviewed journal
and one whose efforts at validation involved having the same person administer questionnaires
to parents and make diagnostic decisions, a pretty sure way to create bias in
the results. It’s not clear on the rest of the site whether IACD even uses the
RADQ, and indeed they should not, because not only is the instrument poorly
validated, its author states perfectly clearly that it is NOT an assessment for
Reactive Attachment Disorder, but for “something else”—Attachment Disorder.
This does raise the question, though--
if IACD does not use the RADQ, why do they post information about it? Is
the answer that they actually do use it, or is the presence of the RADQ on the
site simply a code that communicates to some readers the real belief system at
work here?

I didn’t come here to argue that IACD uses directly
harmful methods, that they killed Candace Newmaker, etc. I do believe that some
psychotherapeutic methods are indirectly harmful, in that they are ineffective
but delude parents into avoiding more effective treatments. This problem points
up questions about the effectiveness of the treatments used by IACD. Exactly
what these are is not obvious, of course; however, some of the articles and
other materials give us an idea. For example, there is a piece by Sebern
Fischer touting neurofeedback, a method that has never been supported by
adequate outcome research. An article by Victoria Kelly claims that physical
contact and eye contact are important factors in treatment of childhood
emotional disorders-- a claim that has
never been supported by evidence, and that in fact has been tested only by
proponents of holding therapy.

There are some other questions that the web site put
into my head, but did not answer. Why does www.instituteforattachment.org
state in a testimonial that a child diagnosed with PDD was successfully treated
with their methods? Is this a claim that PDD is caused by the same factors that
appear to create RAD? Is it that, as someone commenting on this blog remarked
the other day, that all but clearly genetic early mental health problems are
due to attachment difficulties? And what would be the ground for making these
claims?

Another question: children treated at IACD are
apparently sent to “therapeutic foster homes” for periods of months. If the
goal is to create emotional attachment to their parents, what would be the
rationale for this separation? Do Forrest Lien and his staff believe, like the
old holding therapists, that they can create an attachment in a child and then
transfer it from one attachment figure to another? How would that work, when
attachment is a matter of a relationship, not some entity inside the child?

And finally: is it true that IACD uses the
Attachment Disorder diagnosis? When seeking third-party reimbursement, do they
use that term, or do they claim DSM code 313.89, Reactive Attachment
Disorder? It’s my understanding that public funds are received by IACD, and surely
there is a problem if in applying for such funds the organization substitutes
an acceptable diagnosis for one that is not evidence-based.

Until IACD and other organizations can correct their
misinformation and answer these questions, I will continue to hold the position
that attacking attachment therapy is not only an appropriate action in terms of
the evidence-- it is in fact a
professional responsibility.

17 comments:

My son and his wife have become "attached" to this attachment theory with the girl who they adopted at age 10, who is now 14. It seems like a terrible way to treat a child, but they have been told "people will critisize you but only you know what it's like."Members of my family are also alarmed by their tecniques. The child has run away repeatedly.

This is certainly a useful trick for attachment therapists-- warning that there will be criticism, and that the parent should ignore it as ill-informed. How to break through this barrier is a horrible puzzle, because the worse the situation becomes, the more the parents seem to cling to their techniques, and the more the therapists say to "circle the wagons".

I notice that even though I've asked several times for people who as kids were treated this way to comment about how much good it did them, there have never been such comments. Only parents and therapists argue that it's a good idea.

Hi my name is Angelica Katz. I was in Forrest program in colorado from Nov. 14th 2011 to Feb. Something. I ran away from there multiple times, I told my PO and Judge I rather be in jail then spend another day in that treatment center. They were dishonest and abusive people. Now i am 18 and have talked to my parents about that program, and come to find out Forrest and my therapist, Beveraly lied multiple to me, my parents, and treatment team. If you want your child to be scarred more then they already are send them to forrest. He won't let you down.

Dear Angelica-- if you will contact me at jean.mercer@stockton.edu, I can put you in touch with people who can guide you and your parents in complaining about what happened to you. But please understand that if you want to bring a lawsuit you should not let time pass. Now that you are 18, the clock is running, and there are limitations on how late you can sue for personal injury. If you are in Colorado, the new ombudsman may be helpful-- but if you will contact me I can help you find out other approaches as well.

My name is Skyler Sullivan. I was in Forrest Lynn's program from ages 6 to 13. I am 23 now. I have personally experienced the hell that is the institute for attachment and child development. I feel as though my childhood was spent as a slave. They made me cook clean the whole house landscape their property and other menile tasks. Their punishment of you refused... they made you sit in a corner all day if you had to use the restroom then you went in you pants and they would make you just sit there in your own filth while they ignore your exsistance. Its is very neglectful. And you are stripped of any human rights. And the money the get from the state for taking care of you goes to themselves they only but you necessities like twice a year and usually it's cheap like good will or Wal-Mart. Not that I am ungrateful but I hardly think that is fair. And they get away with slamming you and restraining you for talking back. I even had one that was a wrestling coach that practiced his moves on the kids. I was chocked out to the point where in was twitching on the ground and he just laughed and said stop faking.ibam posting this so people see the help that I went thorough and still have night terrors about so parents think twice before sending their kids there. And so people are informed about the injustice that happends

Dear Skyler-- thank you so much for sending this description of your experiences. I want to forward your statement to the Wyoming DHS that presently has a contract with IACD for foster care services.

Would you be willing to tell me what happened after you left IACD? Have you ever been in treatment with a conventional therapist for the effects of your treatment at IACD? Also, have you ever brought a complaint to the Colorado Children's Ombudsman about your experiences?

Dear Skyler -- These people should be in prison for what they did to you and the other children. Society doesn't allow prisoners to be treated like this.

It is very helpful when survivors such as yourself describe the conditions, because places like IACD (Forrest Lien) obviously don't let the public know what it's really like

If you are interested, I'd like you to know that there is a private Facebook site called "Attachment Therapy is Wrong" for survivors, friends and activists who are trying to stop this torture. There are several others who were sent to this outfit in Evergreen.

There is also a website for getting the word out about how abusive this "treatment" is:

http://www.childrenintherapy.org

Some survivors find this website useful because their friends may find it hard to believe how truly bad the sadistic these "professionals" can be.

Jean,I see a lot of criticisms about attachment therapy and facilities here. I'm wondering if you are trying to only help children after they are at these places or want help to families struggling with these children in their home. My son is 13. We adopted him from Russia at 18mos. It is a tragedy that he was unloved during that time, but it is NOT MY FAULT nor the fault of my husband or daughters. Yet our home is a police state. Any door that is unlocked is an opportunity for my son to take something, urinate on it, pour liquid of some kind into it and hide it. Before we realized what he was doing, we would find boots, clothes, etc covered in mold, urine, & soap hidden. No form of punishment deterred him, spankings, groundings, rewarding for good days, making him do extra chores to pay for the damange--NOTHING. As we have increased diligence, that is locking all doors, restricting his access outside, and having constant eyes on him, his poor behavior has escalated. He now wets himself at school several times a week. We put him in pull ups hoping other children would not have to sit in his urine around the room. Then he started taking his penis out of the pull up and urinating down his leg. When he is in a good mood, he asks us to allow him to earn our trust back. I haven't mentioned that we have a baby gate on his door which we zip tie at night so he will have to make noise to get out. (of course he could push it down at any time to get out but never did. I think it provided him a small sense of security) Unfortunately, the other night we forgot the zip tie. He took shampoo from one daughter's room & poured it in a pair of her boots. Then when to the other daughter's room and took 2 pair of boots which he urinated in and soaped up then hide them under a beanbag chair in our playroom (the one room with out a door). His sisters had not locked their rooms as they thought he was secured. One of the girls may have been sleeping in her room at the time. We cannot get a clear answer from him, as you can imagine. This was the 1 time in 9 months we was not zip tied in. You cannot tell me he was not waiting for his opportunity to do this. If he wanted to work on trust, he would not have left his room. His therapist and us have repeatedly told him to come to us when he feels like he is going to do these things and we will try to work thru it rather than do this. He never does come to us. What would you and all the critics of these attachment therapy places have us do? Do we wait til he gets into the knife drawer instead of the shampoo? I like our therapist and he is straight up with my son, but it isn't helping. We use meds, also not helping. With all this criticism, where are your suggestions for help so that people like me, at their wits end, don't have to send our broken children to these places. We have lived like this for nearly 2 years. My son has been asked to leave 1 school and sent for 2 days to the "alternative" school for children who can't function in public school and he just finished 6th grade. I have been trying to find something, ANYTHING, to do with him or for him and all I ever see is criticism of these places. If I google RAD/Attachment disorder, hundreds of thousands of hits come up. What are families like us supposed to do when children simply can't stat in the home any more? He has to go. I can't live like this and can't expect my 20 year old daughters to do it either. God forbid they have children one day and he is still here and 17 or 18. Everytime he does something, it seems to be more unbelievable than the last time. This week, he claimed to be having diarrhea 3-4 times a day (not true for reasons I won't get into) and soiled his pants during the night hiding the underwear under his bed. Is this the next step we have to live with. Perhaps blog about alternatives to attachment facilities instead of just offering criticism.

Dear Anon-- let me say first of all that I am very sorry that your whole family, including your son, are having such difficulties. I am afraid that you have been more victims of the attachment industry, which has convinced you of some explanations and some therapeutic approaches that are not appropriate.

I do not believe that you are doing your son or the rest of your family any good by keeping him in your home when matters have reached this point, but I am afraid that you may choose residential treatment based on the beliefs about attachment you hold. There are very good reasons why there are many criticisms of the kinds of places you are looking at on the Internet.

The problems you describe are not symptoms of Reactive Attachment Disorder or any other attachment-related disorder. However, what you write suggests that you are convinced that these are attachment problems, that he needs treatment for attachment problems, and that attachment therapy is the only answer. You also note that your punishment techniques and constant supervision are not working, so perhaps you can understand that you need to start over in your thinking about this boy.

Can you put attachment and attachment disorders out of your mind for the time being and seek a thorough, objective mental and physical health examination at a reputable children's hospital? I can almost guarantee you that the diagnoses will not include RAD, and you will need to deal with this new information with an open mind rather than allowing yourself to be locked into the attachment disorder story.

Apparently you have tried to use rewards and punishments to shape his behavior, and I congratulate you on making that effort-- but these things are hard to do effectively in a home environment, especially if you are not trained to do them.

Please do get a professional diagnostic work-up and then make your decision about residential care (if needed) by choosing a facility that does not attribute all problems to attachment.

If you have trouble finding a suitable hospital or therapist or RTC, if you will let me know where you live I may be able to find some suggestions for you.

Also-- with respect to the soiling, I want to include here some comments made on a clinical child psychology listserv in answer to a similar question:

Encopresis is sometimes interpreted as volitional but in most cases it involves biological factors, especially constipation, sometimes due to insensitivity to signs of needing to have a bowel movement, which can cause painful bowel movements and avoidance. Sometimes there's fear of using the toilet, or missing other valued activities. Constipation is not always obvious; stools that do pass can be loose. Often it helps to work with pediatrician for medical assessment and disimpaction intervention (enemas and/or oral medications) followed by maintenance therapy (dietary changes increase fiber, oral laxatives). This is integrated with psychosocial intervention (primarily behavioral), including psychoed for parents (on the constipation-encopresis link) enhanced toilet training (relaxation methods, regular toilet sits with reinforcement for sitting and extra for defecating), reinforced pant/underwear checks (rewards for clean pants, having child assist with cleaning soiled clothes though in non-harsh/non-punitive fashion). Consistency and patience (including with relapse) are key.

I am quoting someone else on this but not supplying his name because we have notdiscussed this matter. However, I thought the comments might be useful to you.

Jean; my husband came across your blog after speaking to IACD and requesting an intake package to be sent. We have been following IACD’s blog for about a year now after our daughter’s psychologist met with us and explained it was her professional opinion that our daughter goes to a residential treatment center that specializes in Attachment Therapy specifically for at least one year. She was nine when this recommendation was made. She was 4 when she was diagnosed with RAD. We have been involved in sensory therapy, filial therapy, talk therapy, TBRI, and EMDR therapy since our daughter was 26 months and came into our home. She is now ten years old & we are all desperate for help. In your reply to Anon you offered to help find a professional RTC that you would recommend- we live in TX and would welcome a recommendation.

Hi Jennifer-- I can put out a request for suggestions on a child clinical psychology list if you would like, but I would need to have more information first. It is very common to find that children who are diagnosed with RAD and given certain kinds of treatments should never have been described as having RAD to begin with, so I don't want to ask for suggestions focused on RAD. Could you state for me what moods or behaviors are problematic and originally led you to seek treatment? Would you consider non-residential treatment? I am asking this because I would not really expect the treatments you list to have had much effect, but there are evidence-based treatments that can be used in a family setting. If you would prefer not to give this information as a blog post, contact me at jean.mercer@stockton.edu.

Hi Jean, my daughter was just kicked out of the IACD program after two weeks because she assaulted her therapeutic parent. After reading your comments I am glad that they rejected her. They had her placed on a child psych unit and basically abandoned her there. I was attracted to the family environment offered by the program, not wanting our daughter to become institutionalized; she has already been in a residential treatment facility and a non-public school. Our daughter is primarily violent towards me, her adoptive mother, and she is no longer safe in our home, because, though she is only 10, she is as big as I am. Oddly, she is very affectionate with me, but when she get angry she lashes out violently and attempts to control me. Is this an attachment disorder? I don't know, but I have to find a solution. We are now relinquishing her to foster care. Very sad; this can't be good for her, but I don't know what else to do. We live in San Francisco and would welcome any advice you have. We will be filing a formal complaint against the IACD and would appreciate any direction you can give us on how best to do that as well.

Hi Erika-- so sorry not to answer before-- I was in Australia and didn't have access.

I'm sorry to hear of your experience with IACD and want to encourage you to file a complaint. If you would get in touch with me at Jean.mercer@stockton.edu I can make some suggestions about how to do this.

I doubt that this is an attachment disorder simply because such disorders are diagnosed much too often by alternative therapists and because they actually do not include violent behavior as a symptom. There are a number of other possible reasons for her behavior, including autism. I hope her foster parents will have access to good advice and treatment for her.

Again, please contact me directly and I can give you information to help with your complaint.

To file online complaints against various licensed mental health therapists:

Colorado Board of Social Work ExaminersColorado Board of PsychologyColorado Medical Board (psychiatrist)These boards use the same complaint form here:https://www.colorado.gov/pacific/dora/DPO_File_Complaint

People can get discouraged that the investigation process can be long, maybe a year or two. But even if your complaints do not result in discipline, they will go into the files and may help the next injured person who complains. Likewise, other people who have filed complaints in the past may help prove your case.

The Colorado Children’s Ombudsman office is fairly new, and it is now independent of Colorado DHS; this appears to be a big improvement in investigating complaints.

I wish you the best, and please let us know how things turn out for you and if I can help with anything else.

About Me https://en.wikipedia.org/wiki/Jean_Mercer

Jean Mercer has a Ph.D in Psychology from Brandeis University, earned when that institution was 20 years old (you do the math). She is Professor Emerita of Psychology at Richard Stockton College, where for many years she taught developmental psychology, research methods, perception, and history of psychology. Since about 2000 her focus has been on potentially dangerous child psychotherapies, and she has published several related books and a number of articles in professional journals.
Her CV can be seen at http://childmyths.blogspot.com/2009/12/curriculum-vitae-jean.mercer-richard.html.